Joints of the lower limbs and

joint classification
• A joint is defined as a connection between
two bones in the skeletal system.
• Joints can be classified by the type of the
tissue present (fibrous, cartilaginous or
synovial), or by the degree of movement
permitted (synarthrosis, amphiarthrosis or
diarthrosis).
Classification by type of Classification by degree
tissue: of movement:

•Fibrous – bones connected •Synarthrosis –

by fibrous tissue. immovable.
•Cartilaginous – bones •Amphiarthrosis – slightly
connected by cartilage. moveable.
•Synovial – articulating •Diarthrosis – freely
surfaces enclosed within moveable.
fluid-filled joint capsule.
• Fibrous Joints
• A fibrous joint is where the bones are bound by a tough, fibrous
tissue. These are typically joints that require strength and stability
over range of movement.
• Fibrous joints can be further sub-classified into sutures, gomphoses
and syndesmoses.
• Sutures
• Sutures are immovable joints (synarthrosis), and are only found
between the flat, plate-like bones of the skull.
• There is limited movement until about 20 years of age, after which
they become fixed and immobile. They are most important in birth, as
at that stage the joints are not fused, allowing deformation of the
skull as it passes through the birth canal.
BONES OF THE CALVARIUM AND CRANIAL BASE
• Gomphoses
• Gomphoses are also immovable joints. They are found
where the teeth articulate with their sockets in the maxilla
(upper teeth) or the mandible (lower teeth).
• The tooth is bound into its socket by the strong periodontal
ligament.
• Syndesmoses
• Syndesmoses are slightly movable joints (amphiarthroses).
• They are comprised of bones held together by
an interosseous membrane. The middle radioulnar joint and
middle tibiofibular joint are examples of a syndesmosis joint.
• Cartilaginous
• In a cartilaginous joint, the bones are united by fibrocartilage or hyaline cartilage.
• There are two main types: synchondroses (primary cartilaginous) and symphyses
(secondary cartilaginous).
• Synchondroses
• In a synchondrosis, the bones are connected by hyaline cartilage. These joints are
immovable (synarthrosis).
• An example of a synchondrosis is the joint between the diaphysis and epiphysis of a
growing long bone.
• Symphyses
• Symphysial joints are where the bones are united by a layer of fibrocartilage. They are
slightly movable (amphiarthrosis).
• Examples include the pubic symphysis, and the joints between vertebral bodies.
• By OpenStax College [CC BY 3.0], via Wikimedia Commons
ADJACENT VERTEBRAL BODIES ARE CONNECTED BY
FIBROCARTILAGE AN EXAMPLE OF SYMPHYSIS
• Synovial
• A synovial joint is defined by the presence of a fluid-filled joint cavity
contained within a fibrous capsule.
• They are freely movable (diarthrosis) and are the most common type of
joint found in the body.
• Synovial joints can be sub-classified into several different types, depending
on the shape of their articular surfaces and the movements permitted:
• Hinge – permits movement in one plane – usually flexion and extension.
– E.g. elbow joint, ankle joint, knee joint.
• Saddle – named due to its resemblance to a saddle on a horse’s back. It is
characterised by opposing articular surfaces with a reciprocal concave-
convex shape.
– E.g. carpometacarpal joints.
• Plane – the articular surfaces are relatively flat, allowing the bones
to glide over one another.
– E.g. acromioclavicular joint, subtalar joint.
• Pivot – allows for rotation only. It is formed by a central bony pivot,
which is surrounded by a bony-ligamentous ring
– E.g. proximal and distal radioulnar joints, atlantoaxial joint.
• Condyloid – contains a convex surface which articulates with a
concave elliptical cavity. They are also known as ellipsoid joints.
– E.g. wrist joint, metacarpophalangeal joint, metatarsophalangeal joint.
• Ball and Socket – where the ball-shaped surface of one rounded
bone fits into the cup-like depression of another bone. It permits
free movement in numerous axes.
– E.g. hip joint, shoulder joint.
Different types of synovial joint
 Joints of the lower limbs
• The joints of free lower limb comprise the articulations from
lower extremity, excepted the pelvic girdle:
• Hip
• Knee
• Tibiofibular
• Ankle
• Intertarsal
• Tarsometatarsal
• Intermetatarsal
• Metatarsophalangeal
• Articulation of digits
• The knee joint is a modified, compound hinge
joint and consists of two articulations: the first
between the femur and the tibia, and the second
between the femur and the patella.
• The joint is stabilized by strong muscles and
ligaments, which include
the quadriceps and hamstring muscles, the
anterior and posterior cruciate ligaments,
the medial collateral and lateral collateral
ligaments, and finally, the patellar ligament.
• Cushioning the articular surfaces of the joint are
the medial and lateral menisci, which are semilunar-
shaped fibrocartilages. Additional bursae prevent friction
between the structures supporting the knee joint:
the suprapatellar bursa, and the gastrocnemius bursa.
• Movements occurring at the knee joint
include flexion, extension, and a small degree of medial
and lateral rotation. It is an important joint that helps
transmit the weight of the body to the foot. It is
important for our daily activities, such as walking,
running, and sitting
 TIBIOFIBULAR JOINTS
• There are two joints between the tibia and the fibula:
• The proximal tibiofibular joint/superior tibiofibular joint
is an arthrodial joint between the head of the fibula and
the lateral condyle of the fibula. The articular facets are
covered by cartilage connected by articular capsules.
The proximal joint allows a gliding movement.
• The distal fibrous syndesmosis. An interosseous
membrane also connects the shafts of the tibia and
fibula. The distal joint does not permit any movement.
• Ankle joint
• Also called the talocrural joint, this is a true hinge joint formed between
the articular surfaces of the distal tibia, distal fibula, and the talus. This
functions as a hinge joint allowing plantar flexion, dorsiflexion, and
a small degree of abduction, adduction, and rotation.
• Subtalar joint (talo-calcanean joint)
• It is located distal to the ankle joint and is a synovial joint formed by
the talus and the calcaneus bone. These two bones articulate twice:
anteriorly and posteriorly when the concave area of the talus meets the
convex surface of the calcaneus.
• There are three articular facets between the talus and the calcaneus
called the anterior, middle, and posterior facets. The middle facet is
formed by the sustentaculum tali. The tarsal canal separates the
posterior facet from the other facets.
• The joint capsule is attached to the margins of the articular
surface of both the bones. The ligaments which stabilize this joint
are the medial, lateral, and interosseous talocalcaneal ligaments.
• About 10% of ankle dorsiflexion is due to the subtalar joint. The
joint mainly allows inversion and eversion of the foot.
• Transverse tarsal joint (Chopart’s or mid-tarsal joint)
• This joint consists of two joints: the talocalcaneonavicular
joint and the calcaneocuboid joint. More extensive movements
take place at this joint compared to other tarsal joints. It consists
of a rotator movement whereby the foot may be slightly
extended or flexed while the sole is being everted or inverted.
• Talocalcaneonavicular joint
• This is a synovial, modified ball and socket joint formed by
the talus (representing the ball), calcaneus, and navicular
bones (forming the joint socket). The plantar calcaneonavicular
ligament stabilizes this joint.
• Calcaneocuboid joint
• This joint is formed between the anterior aspect of
the calcaneus and the posterior surface of the cuboid bone. It is
a synovial, saddle type of joint stabilized by the bifurcated
ligament superiorly, the long plantar ligament inferiorly, and
the short plantar ligament deep to the long plantar ligament. The
joint capsule is attached around the margins of the articular
surface. This joint permits inversion and eversion.
• Cuneonavicular joint
• This joint formed by the navicular and the three
cuneiform bones is a synovial joint which
permits gliding movement. The dorsal and plantar
cuneonavicular ligaments stabilize the joint.
• Cuboideonavicular joint
• This is a joint between the cuboid and navicular
bones and is supported by the plantar, dorsal, and
interosseous ligaments. It is a fibrous joint.
• Tarsometatarsal joint
• These are synovial joints formed between the three cuneiform, cuboid,
and the bases of the (1st to the 5th) metatarsal bones. The dorsal,
plantar, and interosseous ligaments stabilize these joints.
• Intermetatarsal joint
• These are synovial joints between the bases of the metatarsal bones. The
plantar, dorsal, and interosseous ligaments stabilize them. The base of the
first metatarsal is not connected to the second via any ligaments.
• Metatarsophalangeal joint (MTP)
• These are joints between the metatarsal heads and the bases of
the proximal phalanges of the toes. The joints are synovial and are
supported by the collateral and plantar ligaments. Due to these joints, we
are able to flex and extend our toes, as well as adduct and abduct them
to keep them apart or bring them closer.
• Interphalangeal joint (IP) of the big toe
• These synovial joints connect the phalanges of the big
toe and are supported by the plantar and collateral
ligaments. It allows flexion and extension of the big toe.
• Proximal interphalangeal joint (PIP)
• This joint is formed between the proximal phalanges and
the middle phalanges of the four lateral toes.
• Distal phalangeal joint (DIP)
• These are joints between the middle and distal
phalanges of the four lateral toes.
 PLANTAR LIGAMENTS
• There are several ligaments which maintain the functional integrity of
the sole of the foot. These are called the plantar ligaments.
• The long plantar ligament connects the calcaneus and the cuboid
bone. It is the longest ligament of the tarsus and converts the groove
on the cuboid into a canal for the fibularis longus tendon. The short
plantar ligament is deep to the long plantar ligament.
• The plantar calcaneocuboid ligament lies deep to the long plantar
ligament and is a short, wide band with great strength.
• The plantar calcaneonavicular ligament connects the calcaneus to the
navicular bone.
• The plantar cuneonavicular ligament is between the navicular bone
and the cuneiform bones.
• The plantar intercuneiform ligaments connect the cuneiform bones.
 ARCHES OF THE FOOT
• There are three arches in the foot: the medial longitudinal arch,
the lateral longitudinal arch, and the transverse arch. The arches of
the foot, along with the bones, joints, muscles, and ligaments, play
an important role in helping the foot absorb shock during walking,
jumping, and running.
• The transverse arch is formed by the cuboid, the three wedge-
shaped cuneiform bones, and the bases of the first to the fourth
metatarsal bones. It creates the medial to lateral mid-foot
curvature, which enables distribution of body weight within the foot
from side to side and navigates uneven ground. It also provides
elasticity to the foot enabling propulsion when walking.
• The medial and lateral longitudinal arches are formed by
the metatarsal bones anteriorly and the tarsal bones posteriorly.
• The metatarsal bones form the medial and lateral longitudinal
arches anteriorly while posteriorly, the tarsal bones form the
arches. At the top of the arch is the talus bone, which receives the
body weight and transfers it to the ground via the anterior and
posterior ends of these arches. At the top of the arch is
the talus bone, which receives the body weight and transfers it to
the ground via the anterior and posterior ends of these arches.
• Disruption of the arches during weight-bearing is prevented by the
strong ligaments connecting the foot bones. The ligaments are
elastic and are able to stretch, thus permitting the arches to stretch
and store energy within the foot. When the weight is removed,
these elastic ligaments recoil, pulling the arches together, releasing
energy, and enabling ergonomic walking.
• Function of the arches
• Distribute body weight from the tibia and fibula to
the foot bones
• Provide the foot with elasticity and resilience
during motion
• Absorb shocks, especially during falls onto the feet
• Help the feet to adapt to uneven surfaces
• Protect the nerves and vessels on the plantar
surface of the foot
• plantar cuneonavicular ligament is between
the navicular bone and the cuneiform bones.
• The plantar intercuneiform ligaments connect
the cuneiform bones.
• The plantar cuboideonavicular
ligament connects the cuboid and navicular
bone.
• The plantar cuneocuboid ligament lies
between the cuboid and the cuneiform bones.